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Open Access Research article

Modification of Peyton’s four-step approach for small group teaching – a descriptive study

Christoph Nikendei1*, Julia Huber1, Jan Stiepak2, Daniel Huhn1, Jan Lauter1, Wolfgang Herzog1, Jana Jünger1 and Markus Krautter3

Author Affiliations

1 Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany

2 Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Heidelberg, Germany

3 Department of Nephrology, University of Heidelberg, Heidelberg, Germany

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BMC Medical Education 2014, 14:68  doi:10.1186/1472-6920-14-68

Published: 2 April 2014



Skills-lab training as a methodological teaching approach is nowadays part of the training programs of almost all medical faculties. Specific ingredients have been shown to contribute to a successful learning experience in skills-labs. Although it is undoubted that the instructional approach used to introduce novel clinical technical skills to learners has a decisive impact on subsequent skills performance, as yet, little is known about differential effects of varying instructional methods. An instructional approach that is becoming increasingly prevalent in medical education is “Peyton’s Four-Step Approach”. As Peyton’s Four Step Approach was designed for a 1:1 teacher : student ratio, the aim of the present study was to develop and evaluate a modified Peyton’s Approach for small group teaching.


The modified Peyton’s Approach was applied in three skills-lab training sessions on IV catheter insertion, each with three first- or second year medical students (n = 9), delivered by three different skills-lab teachers. The presented descriptive study investigated the practicability and subjective impressions of skills-lab trainees and tutors. Skills-lab sessions were evaluated by trainees’ self-assessment, expert ratings, and qualitative analysis of semi-standardized interviews conducted with trainees and tutors.


The model was well accepted by trainees, and was rated as easy to realize, resulting in a good flow of teaching and success in attracting trainee’s attention when observed by expert raters. Qualitative semi-standardized interviews performed with all of the trainees and tutors revealed that trainees valued repeated observation, instruction of trainees and the opportunity for independent performance, while tutors stressed that trainees were highly concentrated throughout the training and that they perceived repeated observation to be a valuable preparation for their own performance.


The modified Peyton’s Approach to instruct small groups of students in skills-lab training sessions has revealed to be practicable, well accepted by trainees, and easy for tutors to realize. Further research should address the realization of the model in larger skills-lab training groups.

Undergraduate medical education; Clinical skills; Catheter insertion; Simulation; Instructional approach; Peyton; Small group teaching